Basic Information
| Provider Information | |||||||||
| NPI: | 1164652251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLESPIE | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 0447 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043161265 | ||||||||
| FaxNumber: | 7043161266 | ||||||||
| Practice Location | |||||||||
| Address1: | 14330 OAKHILL PARK LN | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280783314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043161265 | ||||||||
| FaxNumber: | 7043161266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14293 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 031620 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.